Mail Order Form

Build Your Own

Information

Mail in Your Water Filter Order

You can order any of water filter producds using our fax mail order form. Just enter your name, address phone number and water filter products, then print and fax to us.

Mail Order Form

First Name: 
Last Name:
Address:
City:
State: Zip: Country:
Phone No:
E-mail Address:
Charge card:
Visa/MC/Discover/American Express
Account No: Expiration Date:
CVC Code (3 or 4 digit):
Enter Quantity, Product Description and Price

Quantity Product 1 Price $
Quantity Product 2 Price $
Quantity Product 3 Price $
Quantity Product 4 Price $
Quantity Product 5 Price $

Shipping Charges
Michigan Residents add 6% Sales tax
Total $

Print this form for fax or snail mail orders.